Presentation Format Affects Comprehension and Risk Assessment: The Case of Prenatal Screening

Miron‐Shatz, Talya; Hanoch, Yaniv; Graef, Dana; Sagi, Michal

doi:10.1080/10810730903032986

Cited by 39 publications

(20 citation statements)

References 28 publications

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“…For example, in a study conveying risk reduction of medications for Crohn’s disease, the visual Cates Plot was less convincing and less preferred by participants[26]. Another small study of prenatal screening data found that patients with low numeracy actually did better with a frequency rather than visual schema[27]. This may be due to the fact that numeracy and graphicacy are correlated[28], so the design of the graph or picture is just as crucial to understanding.…”

Section: Discussionmentioning

confidence: 99%

Effect of format on comprehension of adherence data in chronic disease: A cross-sectional study in HIV

Lyons

Bilker

Hines

et al. 2016

Patient Education and Counseling

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Objective To determine which formats communicate medication adherence effectively to patients. Methods HIV-infected adults on antiretrovirals viewed examples of refill data in 5 formats: (1) percentage of doses, (2) number of days late to refill (“days late”), (3) calendar of days with/without medications, (4) pie chart of days with/without medications, and (5) letter grade. Five scenarios (>95%, 90–95%, 80–90%, 70–80% and <70% adherence) were presented in each format. Participants rated scenarios on adherence improvement needed. “Good understanding” was ≥4 of 5 scenarios correct. We calculated odds ratios for “good understanding” using logistic regression with percentage as the referent format. Results 124 participants were median age 48.5, 65% Black, 71% male. Understanding of all formats differed by education (all interaction p values<0.02). For ≤12 years education, odds ratios (OR) of understanding (95% CI) compared to percentage were: days late 3.3 (2.3–4.7), calendar 3.1 (2.2–4.3) pie chart 2.0 (1.4–2.7), and letter grade 1.8 (1.3–2.5) For >12 years education, ORs were: days late 1.3 (0.9–2.0), calendar 2.4 (1.5–3.8), pie chart 2.9 (1.8–4.6), and letter grade 1.7 (1.1–2.6). Calendar plot was most preferred. Conclusions Adherence percentage was the least understood format regardless of education. Practice Implications Calendars should be used to convey adherence information.

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Section: Discussionmentioning

confidence: 99%

Effect of format on comprehension of adherence data in chronic disease: A cross-sectional study in HIV

Lyons

Bilker

Hines

et al. 2016

Patient Education and Counseling

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“…All numerical formats are not equivalent, however, and considerable research has compared, for example, the pros and cons of using frequency formats instead of percentages [1-4] and the potential pitfalls of specific formats such as 1-in-X [5,6] and number needed to treat [7]. In addition, research on affective influences on risk perceptions make it clear that the same risk number can lead to very different feelings about that risk based on different circumstances, presentations, or contexts [8,9].…”

Section: Introductionmentioning

confidence: 99%

Animated Graphics for Comparing Two Risks: A Cautionary Tale

Zikmund‐Fisher¹,

Witteman²,

Fuhrel-Forbis³

et al. 2012

J Med Internet Res

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BackgroundThe increasing use of computer-administered risk communications affords the potential to replace static risk graphics with animations that use motion cues to reinforce key risk messages. Research on the use of animated graphics, however, has yielded mixed findings, and little research exists to identify the specific animations that might improve risk knowledge and patients’ decision making.ObjectiveTo test whether viewing animated forms of standard pictograph (icon array) risk graphics displaying risks of side effects would improve people’s ability to select the treatment with the lowest risk profile, as compared with viewing static images of the same risks.MethodsA total of 4198 members of a demographically diverse Internet panel read a scenario about two hypothetical treatments for thyroid cancer. Each treatment was described as equally effective but varied in side effects (with one option slightly better than the other). Participants were randomly assigned to receive all risk information in 1 of 10 pictograph formats in a quasi-factorial design. We compared a control condition of static grouped icons with a static scattered icon display and with 8 Flash-based animated versions that incorporated different combinations of (1) building the risk 1 icon at a time, (2) having scattered risk icons settle into a group, or (3) having scattered risk icons shuffle themselves (either automatically or by user control). We assessed participants’ ability to choose the better treatment (choice accuracy), their gist knowledge of side effects (knowledge accuracy), and their graph evaluation ratings, controlling for subjective numeracy and need for cognition.ResultsWhen compared against static grouped-icon arrays, no animations significantly improved any outcomes, and most showed significant performance degradations. However, participants who received animations of grouped icons in which at-risk icons appeared 1 at a time performed as well on all outcomes as the static grouped-icon control group. Displays with scattered icons (static or animated) performed particularly poorly unless they included the settle animation that allowed users to view event icons grouped.ConclusionsMany combinations of animation, especially those with scattered icons that shuffle randomly, appear to inhibit knowledge accuracy in this context. Static pictographs that group risk icons, however, perform very well on measures of knowledge and choice accuracy. These findings parallel recent evidence in other data communication contexts that less can be more—that is, that simpler, more focused information presentation can result in improved understanding. Decision aid designers and health educators should proceed with caution when considering the use of animated risk graphics to compare two risks, given that evidence-based, static risk graphics appear optimal.

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“…As a result, patient decision aids and other patient communications that incorporate risk statistics will only be effective in improving patient decision making if they use design features that make these risk communications easier to understand. In this vein, researchers have evaluated the benefits of giving people more intuitive representations of risks by, for example, using frequencies instead of percentages [5-8] and testing a wide variety of visual displays, such as bar graphs, pie charts, and pictographs or icon arrays [9-14]. …”

Section: Introductionmentioning

confidence: 99%

Cool but Counterproductive: Interactive, Web-Based Risk Communications Can Backfire

Zikmund‐Fisher¹,

Dickson²,

Witteman³

2011

J Med Internet Res

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Background Paper-based patient decision aids generally present risk information using numbers and/or static images. However, limited psychological research has suggested that when people interactively graph risk information, they process the statistics more actively, making the information more available for decision making. Such interactive tools could potentially be incorporated in a new generation of Web-based decision aids.Objective The objective of our study was to investigate whether interactive graphics detailing the risk of side effects of two treatments improve knowledge and decision making over standard risk graphics.Methods A total of 3371 members of a demographically diverse Internet panel viewed a hypothetical scenario about two hypothetical treatments for thyroid cancer. Each treatment had a chance of causing 1 of 2 side effects, but we randomly varied whether one treatment was better on both dimensions (strong dominance condition), slightly better on only one dimension (mild dominance condition), or better on one dimension but worse on the other (trade-off condition) than the other treatment. We also varied whether respondents passively viewed the risk information in static pictograph (icon array) images or actively manipulated the information by using interactive Flash-based animations of “fill-in-the-blank” pictographs. Our primary hypothesis was that active manipulation would increase respondents’ ability to recognize dominance (when available) and choose the better treatment.Results The interactive risk graphic conditions had significantly worse survey completion rates (1110/1695, 65.5% vs 1316/1659, 79.3%, P < .001) than the static image conditions. In addition, respondents using interactive graphs were less likely to recognize and select the dominant treatment option (234/380, 61.6% vs 343/465, 73.8%, P < .001 in the strong dominance condition). Conclusions Interactivity, however visually appealing, can both add to respondent burden and distract people from understanding relevant statistical information. Decision-aid developers need to be aware that interactive risk presentations may create worse outcomes than presentations of static risk graphic formats.

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Presentation Format Affects Comprehension and Risk Assessment: The Case of Prenatal Screening

Cited by 39 publications

References 28 publications

Effect of format on comprehension of adherence data in chronic disease: A cross-sectional study in HIV

Effect of format on comprehension of adherence data in chronic disease: A cross-sectional study in HIV

Animated Graphics for Comparing Two Risks: A Cautionary Tale

Cool but Counterproductive: Interactive, Web-Based Risk Communications Can Backfire

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